Waking up: Eliminating parent-to-child HIV transmission

Shobha Shukla - CNS
According to a new UNAIDS report on HIV in Asia and the Pacific, there is mixed progress on eliminating new HIV infections in infants. Cambodia, Malaysia, Myanmar and Thailand have over 50% coverage of all services to prevent PTCT (parent to child transmission) of HIV while Pakistan, Nepal and Sri Lanka lag behind with less than 30%. All countries in the region are trying to introduce WHO recommended PPTCT treatment option B to provide early and immediate ARV treatment to all HIV+ positive mothers. Yet overall there has been only 9% reduction in new infections among infants between 2010 and 2012. Cutting down the number of such infections by 90% requires great effort.

Thailand’s National Early Infant Diagnosis (EID) programme has been working towards achieving this goal as shared by Thananda Naiwatanakul. HIV testing is being provided free of cost through the National Health Security office since 2007. In 2012 HIV prevalence in pregnant women was 0.6% in Thailand. Results of a cluster sampling of 2711 mothers and 2733 infant charts from 2008-2011 revealed that EID coverage among HIV exposed children increased by nearly 80% --from 53% in 2008 to 73% in 2011, and rates of PTCT decreased.

Wang Ailing of China informed that the iPMTCT (integrated Prevention of Mother To Child Transmission of HIV, Syphilis and Hepatitis B) programme of China is an essential part of HIV/AIDS prevention and control. By end of 2012 HIV testing rate during pregnancy had increased to 63.5% and 79% of pregnant women were put on Anti Retro Viral treatment. More than 95% pregnant women got tested for syphilis and HBV in 2012. But specific province based challenges remain in high risk provinces--in South East China focus has to be on migrants to improve follow up of pregnant women and children, whereas in South West China it is on early detection and infant and young child nutrition.

Anandi Yuvraj of India lamented the gap of 56% between pregnant HIV+ women needing ARV for PPTCT and those actually receiving it in 2011 in India. India has an estimated 29 million pregnant women every year, out of which 0.42% were estimated to have HIV in 2011. Dr Raghuram Rao, National Programme Officer shared the country’s strategy of scaling up HIV testing for pregnant women and its integration with Maternal and Child Health. The national strategic plan which is being rolled out in a phased manner, envisions detecting more than 80% HIV infected pregnant women; provide access to PPTCT services to more than 90% of detected pregnant women; provide access to early infant diagnosis to more than 90% HIV exposed infants and provide ARV prophylaxis to 100% HIV exposed infants; and ensure >95% compliance with ART in HIV women and exposed children. In the two states which have implemented this through the WHO option B, more than 90% pregnant women were tested and started on ARV prophylaxis between September 2012-September 2013 and for the women under the programme, transmission rate had gone below 5%.

Scaling up effective interventions for preventing mother-to child transmission will not only reduce rates of transmission and avert new infections in children but also improve overall maternal and family health. Reaching the goal of total elimination has been endorsed, but new interventions by way of technology have to be coupled with leadership and political will. The way forward lies in early detection; early linkage to care and early ART initiation for HIV infected infants; standard treatment and high quality follow up.

Shobha Shukla, Citizen News Service - CNS
November 2013 

Note: This article was first published in 11th ICAAP INSIGHT, the official daily conference newspaper of 11th International Congress on AIDS in Asia and the Pacific (11th ICAAP) in Bangkok, Thailand. This newspaper was managed by Inis Communication and CNS.